Farm Labor Perspectives on Working with Medical Providers

Monolingual Spanish speaking farm workers are extremely vulnerable to pesticide exposure and are often afraid to speak out.

“The risk of developing prostate cancer was 14% greater for the pesticide applicators compared to the general population.” May 1, 2003, American Journal of Epidemiology.

Medical providers can aid farm workers by being on the look-out for pesticide exposures.

Farm workers may not inform the physician about pesticide exposure unless asked.

1. Ask the Right Questions

Where you suspect that the farm worker may have been exposed to pesticides ask questions about his or her work environment.

Keep track of the effects of exposure over time.

Under workers’ compensation, the Department of Labor and Industries will pay for the first visit to the doctor if the injury is work related. To approve the claim:

Must establish injury with “objective medical findings”

clear evidence of exposure

evidence of chemicals or pesticides

2. Worker’s Compensation Claims

Under the workers’ compensation system, the standard principles of toxicology are applied to all exposure claims, including pesticide claims.

The Department requires “objective medical findings” in pesticide exposure claims and accepts such claims, where the following exists:

clear documentation of exposure (blood tests, other confirming tests)

the doctor relates the worker’s complaints/condition to the pesticide exposure

The Department of Labor and Industries generally receives pesticide information under such claims, as growers are required to keep pesticide application records.

The Department can identify pesticide exposure claims by the use of key words such as “spray” or “pesticides” in the Report of Accident form.

Document the farm worker’s pesticide exposure, even where the symptoms of this particular exposure are not acute, as the worker may suffer from cumulative exposures.

3. Indicators of Possible Exposure

Where does the worker live?

Where does the worker work?

Farm workers that reside and/or work in or near orchards or fields are more likely to be exposed to pesticides, even without knowing it. (DOH, Summary Results of Yakima Farmworker Focus Groups About Pesticides and Health Care, 9/22/03
)

Includes:
The new revised version of EPA's pesticide poisoning handbook, 5th edition - Recognition and Management of Pesticide Poisonings edited by Dr. Routt Reigart and Dr. James Roberts, and published by EPA's Office of Pesticide Programs.

Both English and Spanish versions are available in PDF format.

(c.) Haz-Map Database Guide

Hazardous Agents
By Types of Agents
By Adverse Effects
AlphabeticallyOccupational Diseases
By Types of Diseases
By Jobs and Symptoms
AlphabeticallyHigh Risk Jobs
By Types of Jobs
Alphabetically

Includes: National Network of Libraries of Medicine (NN/LM)
The mission of the National Network of Libraries of Medicine (NN/LM) is to advance the progress of medicine and improve the public health by:
1) providing all U.S. health professionals with equal access to biomedical information; and,
2) improving the public's access to information to enable them to make informed decisions about their health. The Program is coordinated by the National Library of Medicine and carried out through a nationwide network of health science libraries and information centers

With the prevalent use of pesticides in agricultural, urban, rural, workplace, and community settings, health care professionals are currently ill prepared to diagnose and treat pesticide-related health conditions. The information presented here has been gathered from various sources including the U.S. Environmental Protection Agency, National Pesticide Telecommunication Network, University Agromedicine Programs, American Academy of Family Physicians, Rachel Carson Council.and others. This information can be useful to health care providers in their education, research and practice to learn and understand more about pesticides issues.

Case example: Physician
misdiagnosed a pesticide
exposure as influenza where he
was unaware that the orchard
where farm worker was
employed had recently been
sprayed.

8. Identifying Patterns

Providers can play an important role in
noting potential health effects. Watch for:

Clusters

Patterns of Acute Effects

Chronic events

Pass information about these patterns to
DOH and academic researchers.

The cluster identification process is
resulting in the Department of Labor and
Industries' Chemically Related Illness
unit generating more referrals to
investigators to look into potential safety
hazards.

A hospital ER worker observed numerous cases
of both acute and chronic and pesticide
exposure.

Confirm that laboratories are sending test
results to the central database.

Tell farm workers and employers about the
need for workplace investigations and
removals when depression thresholds are
exceeded, and of follow up to make sure
those protections are happening. (Extremely
Important!)

Pesticide-related illness is a reportable
condition per WAC 246-101. You can report
by calling the Washington Poison Center at 1-
800-222-1222.

Watch for depressions that are approaching
thresholds and highlight these to workers
and employers.

Watch for clusters of workers with
depressions, even where those depressions
don't exceed the threshold.

Several workers with 19% depressions at one
orchard may signal the need for greater care

10. Share Your Concerns

As persons dedicated to protecting public health, providers are in a unique position, based upon firsthand observations, to educate others regarding the prevention of pesticide exposures to farm workers.

Express concern about allowing the application of highly toxic and volatile pesticides next to fieldworkers/homes/schools, etc.

11. Keep Informed

Contact provider participants about avenues for providing general education.

Increase your knowledge and awareness about pesticide exposure.

"Associations between pesticide use and prostate cancer risk among the farm population have been seen in previous studies; farming is the most consistent occupational risk factor for prostate cancer," Michael Alavanja of the National Cancer Institute.

Collaborate and Communicate with Colleagues.

Know how to recognize and accurately diagnosis acute and chronic pesticide exposures.